Virtual GP or your own doctor

What continuity of care means

Continuity of care means seeing the same doctor, or a small team of doctors, who knows your history over time. The Royal College of General Practitioners calls the relationship between doctor and patient the lynch pin of general practice [1].

The college reports that continuity of care, shared decision making, person-centred care and empathy are strongly associated with patient satisfaction, adherence to medical advice, positive changes in behaviour and patient outcomes. It asks that patients who wish to can see a clinician they know and who knows them [1].

What the research shows about seeing the same doctor

A systematic review of continuity and mortality found 22 eligible studies from nine countries, and 18 of them, 81.8%, reported significantly lower mortality where continuity was higher [2]. The studies were observational, so they show an association, and the effect appeared with both generalist and specialist doctors.

A registry study in Norway followed 4,552,978 people listed with a named general practitioner. Compared with a relationship of one year, people who had kept the same doctor for more than 15 years had lower odds of an acute hospital admission, at 0.72, and of dying, at 0.75, and the effect grew with the length of the relationship [3].

In England, a study of 230,472 older patients found that higher continuity with a general practitioner was linked to fewer admissions for conditions usually managed outside hospital. The authors’ model estimated that a rise of 0.2 in their continuity index would cut those admissions by 6.22% [4].

None of these studies tested remote care directly. They measure the relationship between a person and a doctor, and that relationship can continue by video when the same doctor is on the other end.

What video and telephone consultations do well

Remote consultations suit a large share of everyday care. A systematic review found telephone and video consultations as effective as in-person visits for improving clinical outcomes in adults attending primary care and mental health services, with high patient satisfaction and significant time saved for patients [5].

The same review found high discontinuation rates among some patients, and concluded that remote care is an effective alternative for many patients rather than for all [5]. For a person between flights, a call that settles a prescription, a result, a referral or a worry in 15 minutes is often the right answer.

Video works best for follow-ups, reviewing results, adjusting medicines, mental health reviews and advice before or after travel, when the doctor already knows the person and the history is on file. It works less well for the first presentation of a new problem that needs an examination.

When seeing a doctor in person matters

Some care needs an examination in the room. A person should be seen in person when a diagnosis depends on examining them, when a test such as a blood test or an ECG is needed, when a problem has not settled after a remote consultation, and when something is new and unexplained, such as a lump, a changing mole, unexplained weight loss or a persistent cough.

Chest pain, sudden weakness, difficulty breathing or heavy bleeding need emergency care, and the right call is the local emergency number. A good remote service says so plainly and quickly.

The strongest arrangement lets the doctor who spoke to a person by video examine them in a clinic afterwards, with the same notes. Continuity then survives the change of setting.

Questions to ask of any virtual GP service

The answers show whether a service gives your people a doctor who comes to know them, or a different voice each time.

• Will a person speak to the same doctor again, or to whoever is free?
• Can the doctor who consulted by video also see the person in a clinic?
• Who holds the notes, and can the person and their other doctors see them?
• How quickly can a person be seen in person, and in which cities?
• Can the doctor issue prescriptions and referrals that work where the person lives?
• What happens out of hours, and when a person is abroad?
• Is there a named doctor for each person, and for each leader?
• Can a person request a longer appointment when a problem needs more time?

How The Wellness for teams brings both together

The Wellness for teams is one membership for the whole firm, its leaders and their families, with inpatient, outpatient and dental care, diagnostics and health programmes in 13 cities. The same GMC registered doctors consult by video and in person, so a person who calls from an airport can later be examined by the doctor they spoke to.

A telephone consultation lasts 15 minutes and is available the same day, at a published fee of £59. One concierge arranges everything, the company receives one invoice a year and sees anonymised reporting only, and leaders can start in one morning.